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TRANSFORMATIONAL LEADERSHIP, COLLABORATIVE NURSE
MANAGEMENT AND THEIR RELATIONSHIPS TO STAFF NURSE JOB
SATISFACTION
_______________
A Thesis
Presented to the
Faculty of
San Diego State University
_______________
In Partial Fulfillment
of the Requirements for the Degree
Master of Science
in
Nursing
_______________
by
Eman Saud Almutairi
Spring 2011
iii
Copyright © 2011
by
Eman Saud Almutairi
All Rights Reserved
iv
ABSTRACT OF THE THESIS
Transformational Leadership, Collaborative Nurse Management and their Relationships to Staff Nurse Job Satisfaction
by Eman Saud Almutairi
Master of Science in Nursing San Diego State University, 2011
Purpose The purpose of this study was to explore the relationships among leadership style of the manager, the level of collaborative behavior between the clinical nurses and the manager as perceived by the clinical nurse, and their relationships to job satisfaction. Secondly, the study will compare nurses’ perceptions of transformational leadership, nurse-manager collaborative relationship and job satisfaction between hospitals in Saudi Arabia (SA) as compared to hospitals in the southwestern of the United States (US) to determine the cultural influence on these variables. Significance Understanding the impact of leadership styles and collaborative behavior between managers and nurses will lead to improvements in leader-employee relations, and ultimately, positively influence employee job satisfaction. Hypotheses
1. Transformational leadership will be positively correlated with job satisfaction.
2. Higher levels of nurse-manager collaboration will be positively related to job satisfaction.
3. There will be a positive relationship between transformational leadership and nurse-manager collaboration.
4. There will be significant differences in the nurses’ perceptions of transformational leadership, nurse-manager collaboration, and job satisfaction between hospitals in SA and the US.
Methodology This study uses a mixed methodology with a descriptive correlational and comparative design to determine relationships among the study variables and differences between nurses working in 2 hospitals in SA with 3 hospitals in the same healthcare system in the US (San Diego) A randomized sample of 90 staff nurses was drawn from the population of nurses working in the study hospitals. Only Registered Nurses were included in the study. Instruments Four instruments were used in the study: 1) a demographic survey used to describe the sample and control for confounding variables, 2) the Multifactor Leadership Questionnaire (MLQ), 3) the Collaborative Behavior Scale (CBS), and the 4) Index of Work Satisfaction (IWS).
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Results Transformation leadership (r = -.493**) and nurse manager collaboration (r = -.602**) were negatively correlated with job satisfaction as measured by the total IWS scale which did not support Hypotheses 1 & 2. Transformation leadership was significantly and positively correlated with nurse manager collaboration (r = .643**) which supported Hypothesis 3. There were significant differences between the SA nurses perceptions and the US nurses perceptions on all three instruments which supported Hypothesis 4. This is the first study demonstrating significant correlations between transformational leadership and nurse manager collaboration.
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TABLE OF CONTENTS
PAGE
ABSTRACT ............................................................................................................................. iv
LIST OF TABLES ................................................................................................................... ix
LIST OF FIGURES ...................................................................................................................x
ACKNOWLEDGEMENTS ..................................................................................................... xi
CHAPTER
1 INTRODUCTION .........................................................................................................1
Significance..............................................................................................................1
Definitions of Variables ...........................................................................................2
Research Questions ..................................................................................................2
2 CONCEPTUAL FRAMEWORK ..................................................................................3
3 REVIEW OF LITERATURE ........................................................................................5
Transformational Leadership and Job Satisfaction ..................................................5
The Managers’ Transformational Leadership Style and Job Satisfaction of Nurses ......................................................................................................................5
Collaboration between Nurses & Managers ............................................................7
Research Hypotheses ...............................................................................................7
4 METHODOLOGY ........................................................................................................8
Research Design .......................................................................................................8
Sample and Sampling Method .................................................................................8
Protection of Human Subjects .................................................................................9
Data Collection ........................................................................................................9
Instrumentation ......................................................................................................10
Multifactor Leadership Questionnaire (MLQ) .................................................10
The Collaborative Behavior Scale (CBS) ........................................................10
Index of Work Satisfaction (IWS) ...................................................................11
Data Analysis .........................................................................................................11
5 RESULTS, DISCUSSION, AND RECOMMENDATIONS ......................................13
vii
Sample Characteristics ...........................................................................................13
Saudi Arabian (SA) Hospitals ................................................................................13
United States Hospitals ..........................................................................................14
Instrument Reliability ............................................................................................14
The MLQ ...............................................................................................................14
The Collaborative Behavioral Scale (CBS-NM) .............................................14
The Index of Work Satisfaction (IWS) ............................................................15
Demographic Differences bewteen Study Groups .................................................15
Results ....................................................................................................................16
Hypothesis 1.....................................................................................................16
Hypothesis 2.....................................................................................................16
Hypothesis 3.....................................................................................................17
Hypothesis 4.....................................................................................................17
Post-Hoc Analysis ..................................................................................................18
Implications for Nursing ........................................................................................19
Limitations .............................................................................................................20
Internal Validity ...............................................................................................20
History........................................................................................................20
Selection Bias.............................................................................................20
Testing Effects ...........................................................................................21
Instrumentation ..........................................................................................21
Research Design .........................................................................................21
External Validity ..............................................................................................22
Suggestions for Further Research ..........................................................................22
Conclusions ............................................................................................................22
REFERENCES ........................................................................................................................24
APPENDIX
A DEMOGRAPHIC SURVEY .......................................................................................26
B MULTIFACTOR LEADERSHIP QUESTIONNAIRE ..............................................29
C INTRODUCTORY LETTER ......................................................................................32
D FLYER .........................................................................................................................34
E NURSE-MANAGER COLLABORATIVE BEHAVIOR SCALE .............................36
viii
F THE INDEX OF WORK SATISFACTION................................................................39
G TABLES ......................................................................................................................43
ix
LIST OF TABLES
PAGE
Table 1. Demographics Comparisons ......................................................................................44
Table 2. Instrument Reliabilities ..............................................................................................46
Table 3. Total Scale Mean Scores for Total Sample ...............................................................46
Table 4. Mean Scores for Study Variables by Country ...........................................................46
Table 5. Correlations Among Study Variables ........................................................................47
Table 6. Test of Significant Differences between SA and US Nurses Perceptions on Study Variables ............................................................................................................48
x
LIST OF FIGURES
PAGE
Figure 1. Conceptual model of the relationships among transformational leadership, nurse- manager collaboration and job satisfaction. ........................................................3
xi
ACKNOWLEDGEMENTS
I would like to thank Jaynelle Stichler, DNSc, RN, FACHE, FAAN for her guidance,
advice, and moral support that contributed to the successful completion of my work. Also, I
would like to thank Dr. Willa Fields, Dr. Lisa Kath, and Dr. Dale Glaser who also
contributed their time on the Thesis Committee. Finally, I would like to thank ARAMCO
Company for their financial support.
1
CHAPTER 1
INTRODUCTION
In work settings, supervisors not only represent the organization’s culture, but they
also exert a direct influence upon subordinates’ behaviors. Supervisors who enable
employees to participate more in decision making and who encourage a two-way
communication process tend to generate a favorable climate within the nursing team,
characterized by less interpersonal conflict and hostility and fewer uncooperative
relationships (Stordeur, D’hoore, & Vandenberghe, 2001). This managerial style can be
characterized as transformational leadership style.
Transformational leadership styles that act on employee concerns about open
communication, acknowledgement of work well-done, encouragement of employee growth
and autonomy increase job satisfaction among staff nurses. Leaders, who ask questions,
listen, provide the necessary supplies and support, match employees’ interests and abilities to
their job functions, and practice collaborative nurse management behavior add meaning to
the work of nurses, all of which result in high job satisfaction. Also, leaders with these
attributes are often characterized as transformational. Adjustments in leadership style reflect
attention paid to the work-related abilities, needs, and desires of individual nurses in
conjunction with work-related demands and developmental plans.
The purpose of this study is to explore the relationship among transformational
leadership of the manager and collaborative nurse management as perceived by the clinical
nurse and its relationships to job satisfaction.
SIGNIFICANCE
When employees experience job dissatisfaction, they may leave the agency that hired
them negatively affecting the agency’s budget. Because leadership style can directly affect
employee satisfaction and growth, it therefore can affect the well-being of patients and their
families. When leaders appreciate and recognize the work of their subordinates, they serve as
role models of encouragement. These kinds of positive relationships create a pleasant and
2
safe working environment. Understanding the impact of leadership styles and collaborative
nurse management will lead to improvements in leader-employee relations and positively
influence employee job satisfaction.
DEFINITIONS OF VARIABLES
This study focused on three specific variables of interest: (1) Transformational
leadership, (2) nurse-manager collaborative behavior, and (3) job satisfaction which are
defined conceptually below:
Transformational Leadership: “Transformational Leadership is defined as a leader who
inspires and transform follower” (Huber, 2006, p. 892). “Transformational leadership is
viewed as a dynamic leader-follower dyad, concerned with second order change
(transformational processes) and associated processes that relate to the higher order needs of
individuals” (Medley & Larochelle, 1995, p. 64).
Collaborative Behavior: Collaboration between the nurse manager and his/her staff is
defined as an open, communication style characterized by mutual respect, sharing of power,
information and resources, and interpersonal valuing (Stichler, 1995).
Job Satisfaction: Job satisfaction is defined as the favorableness or favorableness with
which employees view their work (Grieshaber, Parker & Deering, 1995). Job satisfaction is a
statement that describes the feelings of employees about their work (Arches, 1991).
RESEARCH QUESTIONS
1. What are the relationships among transformational leadership, nurse-manager collaboration and staff job satisfaction?
2. What is the difference in the nurse perceptions of transformational leadership, nurse-manager collaboration and job satisfaction between Saudi Arabian hospitals and hospitals in the US?
The next section discusses the conceptual framework which explains the relationships
among the variables of interest in this study.
3
CHAPTER 2
CONCEPTUAL FRAMEWORK
The theoretical framework used to explain the relationships among the variables of
interest in this study was Bass and Avolio’s Augmentation Model of Transactional and
Transformational Leadership (Bass & Avolio, 2004; Huber, 2006). This theory explains that
there is a relationship between the leader’s style of leadership and the job satisfaction of the
follower. Bass and Avolio also indicate that there are different styles of leadership such as
transformational, transactional and laissez-faire that have different effects on the followers’
motivational levels, job satisfaction, and organizational commitment. The transformational
style influences the follower with a charismatic style that includes: (1) idealized influence
that creates a sense of pride and engagement in to leader’s vision and mission; (2) idealized
behavioral influence where the leader role models the ideal behaviors; (3) inspirational
motivation by inspiring the followers to engage with the leader’s vision; (4) intellectual
stimulation which motivates the follower to be more creative and innovative in his/her
thinking; and (5) individualized consideration which is characterized by a feel of personal
mentoring.
There is evidence in the literature to support Bass and Avolio’s (2004) theory about
the strong relationships between the clinical nurses’ perceptions of their manager’s
leadership style and collaborative behavior and their job satisfaction. Using this theory, a
conceptual model (see Figure 1) was developed which describes the relationships among
transformational leadership and collaborative nurse-manager relationships as perceived by
Conceptual model:
Transformational leadership +
+ Job Satisfaction
NM Collaboration +
Figure 1. Conceptual model of the relationships among transformational leadership, nurse- manager collaboration and job satisfaction.
4
the clinical nurse and staff nurses’ job satisfaction.
The next section provides a review of the literature that supports the relationships
among the variables of interest in the study.
5
CHAPTER 3
REVIEW OF LITERATURE
The purpose of the review of the literature is to examine evidenced based literature
that supports the relationships among the study variables.
TRANSFORMATIONAL LEADERSHIP AND JOB
SATISFACTION
Transformational leadership has been defined by several authors (Failla & Stichler,
2008; Huber, 2006; Roussel, 2009) and for this study is defined as a leader who inspires their
colleagues and followers to accomplish far more than they ever thought possible (Stichler,
2009). Transformational leadership is different from transactional leadership because it
focuses on internal and value based changes in the individuals that causes them to adopt the
new proposed changes and motivates them to perform to their fullest potential.
THE MANAGERS’ TRANSFORMATIONAL LEADERSHIP
STYLE AND JOB SATISFACTION OF NURSES
Transformational leadership style has been associated with higher levels of job
satisfaction in several studies. Failla and Stichler (2008) in a study comparing the managers’
(n = 14) perception with the staff nurses’ (n = 76) perception of the managers’ leadership
style reported that there were no significant differences between the managers’ perceptions
when compared to the staff’s perception on the total MLQ scale, however there managers
rated themselves slighter higher on the total transformational scale. There were significant
differences noted on two subscales: (1) intellectual stimulation which refers to influencing
followers to think in new ways (F 1,88 = 5.22, p = .025) and (2) individual consideration
(mentoring staff followers and following up with appreciate feedback when the goals were
accomplished (F 1,88 = 4.93, p = .029). This study also found significant relationships
between transformational leadership and job satisfaction on 3 subscales of the Index of Work
Satisfaction (IWS): (1) autonomy (r = .33, p = .004; (2) professional status (r = 0.246, p =
.032, and 3) organizational policies (r = .380, p = .001). By contrast the authors indicated that
6
transaction leadership only had a weakly positive correlation with job satisfaction on one
subscale of the IWS: (1) organizational policies (r = .248, p = 0.31). The Failla and Stichler
(2008) study is important to this study since it supports the hypothesized correlations
between transformational leadership and job satisfaction and uses the same instruments to
measure two variables of interest in this study.
Similarly, in another study done by Mcguire & Kennerly (2006), showed that leaders
who practice transformational leadership are admired and respected by their followers, and
their followers experience increased organizational commitment (r = 0.39, p < .01).
Organization commitment is viewed as the result of a satisfied employee. (Huber, 2006;
Roussel, 2009).
A study done by Medley & Larochelle (1995) suggested that transformational
leadership correlated positively with job satisfaction (r =.4010; p < .001) The quality of the
leader-employee relationship has an impact on the employee’s self-esteem and job
satisfaction (DeCremer, 2003). Leadership plays a central role in ensuring job satisfaction
among employees. For nurses, a transformational leadership style positively correlates with
job satisfaction. Moreover, leadership has further major implications in the hospital
production process (Stordeur et al., 2001). Leadership quality is a core element of
management. It is not only strongly related to the level of employee satisfaction, but it is also
logically linked to organizational performance, climate and culture, turnover, and patient
satisfaction (Rogg, Schmidt & Shull, 2001).
According to Chin Chen and Baron (2006), staff nurses in Taiwan may experience an
increase of burn out and dissatisfaction because nursing leaders rarely has leadership training
in Taiwan. The study examined staff nurses’ perceptions of nursing directors’ leadership and
their job satisfaction levels to understand how perceptions of leadership styles related to job
satisfaction in Taiwan. The findings indicated that when transformational leadership was
implemented more frequently in their workplaces, then Taiwan’s staff nurses were
moderately satisfied in their jobs.
“At the core of transformational leadership is the notion that employees are willing to
make an extra effort to achieve their goals and move beyond immediate self-interest and to
work towards the improvement of the product/service and develop the organization”
(Nielsen, Yarker, Brenner, Randall & Borg, 2008, p.467).
7
COLLABORATION BETWEEN NURSES & MANAGERS
Collaborative nurse management facilitates employees to overcome major and minor
changes in the work setting which can lead to high productivity and problem solving. In a
study done by Dumpe (1996), a task force assembled to build a new delivery system during
the merger of two hospitals. The task force failed to implement the change due to the lack of
manager support. Units were very busy and nurses were not supported during the transitional
process to attend the classes. Lack of nurse- manager collaboration negatively affected the
success of the merger transition process.
Nurse mangers should be prepared to help their staff regulate changes that affect their
practice. Developing greater commitment within all departments can be obtained when the
nurse manager inspires followers to go beyond sufficiency to strive for excellence
(O’Connor, 1996).
In a study by Stichler (1990) Nurse-manager collaborative behavior and job
satisfaction were accounted for 31% of the explained variance in anticipated turnover. “True
collaboration is an unconditional component in fostering the culture of a healthy work
environment in a health care organization” (Vollers, Hill, Roberts, Ambaugh, & Brenner,
2009, p.23) Collaboration is seen as an important mechanism for promoting leadership
(Welch & Tulbert, 2000).
RESEARCH HYPOTHESES
Based on the review of the literatures and the theoretical framework which explained
the relationships among variables, the following research hypotheses were generated for the
study.
1. Transformational leadership will be positively correlated with job satisfaction.
2. Higher levels of nurse-manager collaboration will be positively related to job satisfaction.
3. There will be a positive relationship between transformational leadership and nurse-manager collaboration.
4. There will be significant differences in the nurses’ perceptions of transformational leadership, nurse-manager collaboration, and job satisfaction between hospitals in SA and the United States US.
8
CHAPTER 4
METHODOLOGY
This section will describe the study design, sample, data collection and analysis for
the study.
RESEARCH DESIGN
This research study used a cross-sectional descriptive correlational and comparative
design to examine the relationship and differences in transformational leadership, nurse
manager collaborative behavior and job satisfaction in two SA hospitals and three US
hospitals. Pearson Product moment correlations were used to determine correlations among
the three study variables of interest and ANOVA was used to determine if there were
differences in the three study variables in Saudi Arabian (SA) hospitals as compared to
United States (US) hospitals located in the southwestern region of the US. The correlation
study examined the relationships among transformational leadership, nurse-manager
collaborative behavior and job satisfaction.
SAMPLE AND SAMPLING METHOD
A convenience sample of hospitals (3 in US and 2 in SA) was used for recruiting
nurses to participate in the study. A number was chosen at random and every nth nurse was
selected from the hospital list. A packet with this nurse’s name was given to the nurses
chosen at random from the hospital’s list of nurses. According to Polit and Beck (2004)
approximately 175 subjects in the US hospitals and 175 subjects in the SA hospitals were
needed to achieve a power of .80 with an effect size of .30 and an alpha of .05. Only 55
subjects were obtained in SA and 35 from the US. hospitals; therefore, the sample size was
not sufficient to power the study. The study is considered to be a pilot study to guide future
research. Each subject was asked to complete a demographic survey (Appendix A), as well as
the study instruments.
The sample included both males and females who worked full time, as staff nurses
The investigator collected information on the demographic data sheet (Appendix B) related
9
to their age, years of employment at the organization, years as a nurse, highest degree earned,
and clinical unit assignment. Only English speaking Registered Nurses (RNs) were included
in the study because the surveys were printed in English, and non-English speaking, non-RN
nurses were excluded from the study. It should be noted that in the SA hospitals, it is
mandatory that all RNs speak English.
PROTECTION OF HUMAN SUBJECTS
Approval to conduct the study was obtained from Human Subject Institutional
Review Board (IRB) at San Diego State University (SDSU) and the participating hospitals.
The subjects chosen at random were asked to read an informational letter outlining
the purpose of the study, how to participate by completing the study instruments or how to
opt out of the study. In addition to the consent forms (Appendix C), the subjects were asked
to complete the demographic and instrument packet. Subjects were assured that their
individual responses would not be identified since personal identifiers were not requested;
therefore, the responses were anonymous. Subjects were told that they could withdraw from
the study at any time and that
Only aggregated data was reported.
DATA COLLECTION
After permission was obtained from all IRBs, a list of all RN’s working in each of the
hospitals was obtained from Human Resources. A number was chosen from a group of
numbers from 1-10 that were placed in a box. Once the number was drawn, then every nth
nurse was chosen from the hospital list. A packet with this nurse’s name was given to the
nurses chosen at random. Arrangements were made to attend management meetings at each
of the hospitals in the study to familiarize the managers with the purpose of the study. The
Principal Investigator distributed flyers (Appendix D) in the staff lounges explaining the
study’s purpose and how subjects could elect to participate. Each instrument packet that was
distributed to each of the nurses selected random from the list of all nurses in the hospital
contained a stamped return envelope addressed to the Principal Investigator for collection of
the completed research forms.
10
INSTRUMENTATION
The next section provides a summary of the instruments used to operationalize the
variables of interest in the study.
Multifactor Leadership Questionnaire (MLQ)
Bass and Avolio’s (2004) Multifactor Leadership Questionnaire (MLQ) was used to
operationalize the concept of leadership style and specifically transformational leadership.
The MLQ contains 45 items tapping nine conceptually distinct leadership factors and three
leadership outcomes. Five scales were identified as characteristic of transformational
leadership which are idealized influence attributed and behavior, Inspirational motivation,
Individual consideration, and Intellectual stimulation. These five scales will be used to test
the hypotheses in this study. Three scales were defined as characteristic of transactional
leadership including contingent reward, management-by exception active, and management-
by-exception-passive. The MLQ is the most widely used instrument to assess
transformational leadership theory and is well thought-out the best validated measure of
transformational and transactional leadership (Hinkina & Schriesheimb, 2008).
The MLQ is the best researched measure of leadership. It shows strong validity with
constructive and content validity indices of.74 and.94 (Bass & Avolio, 2004). The internal
consistency of the Multifactor Leadership Questionnaire was reported with a Cronbach's
alpha coefficient of .70 for all scales. The Multifactor Leadership Questionnaire was an
appropriate instrument to measure multidimensional nursing leadership, since validity and
reliability were supported. (Hinkina & Schriesheimb, 2008).
The Collaborative Behavior Scale (CBS)
The Collaborative Behavior Scale’s (CBS) purpose is to determine the extent of
collaboration behaviors which generally exist between nurses and their managers (Stichler,
1990). The CBS (Appendix E) is a four point Likert-type scale with response options ranging
from "rarely"(1) to "nearly always"(4). The higher the total score, the more collaborative the
relationship. The 20 item CBS was developed using the theoretical work of Homans (1950).
The content validity index (CVI) for the original instrument was reported as .91.
Factoral validity was established using an alpha factoring technique. Varimax rotation
yielded a simple structure with seventy-three percent (73%) of the variance attributed to
11
Factor 1. Factor loadings ranged from .79 to .92. The final 20 item Collaborative Behavior
Scale (CBS) - nurse-manager (N-M) was designed as a self-report measure that can be used
to determine the extent of respondents' perception of collaborative behaviors in relationships.
Reliability was initially tested using Cronbach's alpha with item total correlations ranging
from .78 to .90 and a standardized item alpha of .98. Further psychometric testing of the
CBS-N-M had a Cronbach's alpha of .96 with an inter-item correlation of .57 (n =188).
Convergent and discriminate validity of the instrument was confirmed using a multitrait-
multimethod approach which correlated the CBS with the Kilmann and Thomas’ MODE
Conflict resolution scale (r-=.22, p< .01). The CBS-N-M was then correlated with the Weiss
Collaborative Practice Scale (r = .41) giving further support for the convergent validity for
the CBS. Discriminate validity was confirmed with the bivariate correlations between CBS-A
and the Physician-Nurse Stress subscale (r = -.21). It is highly reliable and valid for use in
determining the nurses’ perceptions of nurse-manager collaboration.
Index of Work Satisfaction (IWS)
The concept of job satisfaction was operationalized using the Index of Work
Satisfaction (IWS) (Stamps & Piedmonte, 1986). IWS (Appendix F) is the most widely used
measure of nurses’ job satisfaction found in the literature. The IWS includes Likert type
questions and subscales that measure professional status, task requirements, autonomy,
interactions with other nurses, and pay. It has been used extensively in the United State,
Japan, and Hong Kong in a variety of teaching, rural, and community setting, including acute
care, long-term care critical care, psychiatry, medicine, surgery, and pediatrics. The content
validity index (CVI) for the instrument was reported as .87 (Stamps & Piedmonte, 1986).
Reliability for the scale reported a Cronbach’s alpha of .82 (Doran, 2003, p. 300-302).
DATA ANALYSIS
The results of the surveys were entered into an Excel spreadsheet to compile the raw
data. Any incomplete survey or a survey meeting the exclusion criteria was discarded. The
compiled data was analyzed in a statistical software program. The Statistical Package for the
Social Sciences (SPSS, version 18.0.0, SPSS, Inc., Chicago) was used for data analysis. For
the IWS instrument several items were reversed according to the directions noted by Stamps
and Piedmont (1986). The following items were reversed in SPSS: 2, 4, 7, 8, 10, 12, 15, 17,
12
18, 20, 21, 23, 27, 28, 30, 31, 33, 35, 36, 39, 41, and 44. Cronbach’s alpha reliabilities were
performed to test the reliability of the three instruments with this sample and study design as
compared to previously published studies and to determine how the instruments faired with
these subjects in this study design. Next, tests for skewness and kurtosis were performed on
the data to assess whether the curves are normally distributed and no evidence of skewness or
kurtosis was found.
For this correlation study, a parametric Pearson r correlation coefficient was used to
test the hypothesis that there was a relationship among the study variables (Transformational
leadership and collaborative behavior as independent variables and job satisfaction as the
dependent variable) and the continuous demographic variables. When the data was normally
distributed, a parametric statistic was used to test the hypothesis. Non-parametric statistics
were also used to test correlations between non-continuous demographic variables and the
study variables. All continuous variables that were significantly correlated with job
satisfaction were entered into a multiple regression analysis with job satisfaction as the
dependent variable to determine how much variance in job satisfaction was explained by
each of the independent variables. A p value of .05 determined the significance of the
findings.
Descriptive statistics (means, standard deviations and frequencies) were used to
describe the sample from the demographic information. To determine differences between
the nurses working in the US hospitals as compared to the SA hospitals, an independent t test
was computed for the parametric demographic data and a Chi-Square test for the non-
parametric data. To test the difference in the mean scores on each of the study variables
(leadership style, collaborative behavior and job satisfaction) between the US hospitals and
the SA hospitals, an ANOVA was computed.
13
CHAPTER 5
RESULTS, DISCUSSION, AND
RECOMMENDATIONS
This chapter comprises the results from the data analysis including the sample
characteristics, instrument reliability coefficients, and results of the hypothesis testing,
discussion of findings, study limitations, nursing implications, and recommendations for
further nursing research.
SAMPLE CHARACTERISTICS
The participants in the sample were randomly drawn from three convenience US
hospitals and two SA hospitals. A total of 350 questionnaires were distributed to enhance the
probability of receiving the desired sample size of 175 participants for each group (US
hospitals and SA hospitals). A total of 90 nurses returned the questionnaires for an overall
response rate of 25.7%. 175 questionnaires were distributed in SA with 55 returned for a
response rate of 31% and 175 questionnaires were distributed in the US with 35 returned for
a response rate of 20%. The SA hospitals comprised 61% of the total sample (n =55), and the
US hospitals comprised 39% of the total sample (n = 35). The sample characteristics will be
described in the next section for each sample group. Table 1 (in Appendix G) outlines the
characteristics of the sample.
SAUDI ARABIAN (SA) HOSPITALS
The SA Hospitals had the highest response rate of 31% including only the nurses who
met the study criteria. This group also had a mean age of 36.7 years (SD = 7.72, n = 55). The
primary ethnicity of this group was Asian (49.1%), followed by Arabic (40%), white (5.5%),
and other (3%). The frequency of first degree earned was predominantly a Baccalaureate
degree in Nursing (37), followed by diploma (17), an Associate Degree (1) and a Masters
degree in another field (0). The mean years at the current hospital for this group was the
highest 2.13(SD = .546).
14
UNITED STATES HOSPITALS
The US hospitals had a response rate of 38% including only the nurses who met the
study criteria. This group had a mean age of 38.34 (SD = 10.46, n = 35). The primary
ethnicity of this group was white (34.3%), followed by Asian (42.9%), Hispanic or Latino
(20%), and other (1%). The first degree earned was master degree in nursing (2), by
Baccalaureate (16), Associate Degree (13), and a Diploma in Nursing (1). The mean years at
the current hospital for this group was the lowest at 2.03 years (SD = .169).
INSTRUMENT RELIABILITY
The reliability of the three instruments, the MLQ, the CBS-NM and the IWS used for
this study was analyzed using the Cronbach’s alpha (α) reliability testing. In the following
section the findings are discussed. Table 3 (in Appendix G) outlines the reliabilities of the
instruments used in this study as compared to reliabilities reported in the literature.
THE MLQ
Bass and Avolio’s (2004) Multifactor Leadership Questionnaire (MLQ) was used to
operationalize the concept of leadership style and specifically transformational leadership.
Only the five scales that were identified as characteristic of transformational leadership were
used to test the hypotheses in this study. The internal consistency of the Multifactor
Leadership Questionnaire was reported with a Cronbach's alpha coefficient of .70 for the
total transformational scale. In this study (n = 90), the Cronbach’s alpha coefficient was
much higher at a = .896.
The Collaborative Behavioral Scale (CBS-NM)
The Collaborative Behavior Scale (CBS)-NM was used to measure the respondents’
perceptions of collaboration between nurses and managers. Cronbach’s alpha was used to
determine the reliability of the CBS-NM with this study sample. The total CBS-NM scale
yielded an excellent reliability of α = .96 the same as the internal reliability levels reported by
Stichler (1990) at Cronbach’s alpha α=.96.
15
The Index of Work Satisfaction (IWS)
The IWS scale allows measurement of the extent of nurses’ job satisfaction. The IWS
has 7 subscales and 44 items. Only the total IWS scale was used to test the hypotheses in this
study. The total IWS reliability for this study was excellent at α = .87 similar to the internal
reliability reported by Stamps and Piedmonte (1986) with Cronbach’s alpha ranging from a =
.69 to a = .83 for other studies. Reliability coefficients for the instruments used in this study
and those reported in the literature.
DEMOGRAPHIC DIFFERENCES BEWTEEN STUDY GROUPS
Demographic data were analyzed to describe the total sample and the separate SA and
US hospital samples and to determine differences between the nurse groups of the SA and
US hospitals.
The sample (n = 90) consisted of 55 nurses (61%) from SA and 35 nurses (39%) from
the US. For the total sample, the age of the respondents ranged from 24-63 years with the
mean age of 37.3 years (SD = 8.87) and the nurses had a mean of 8.90 (SD = 6.84) years of
employment at their current hospital which indicates that the total sample was fairly
experienced. Interestingly there were no significant differences noted in the ages between the
SA sample (age, 36.7 years, SD = 7.72) and the US sample (age 38.34 years, SD = 10. 46) or
in the years of experience in their current hospital (SA= 2.13 years, SD = .55; US = 2.03
years, SD = .17). There were 46 females and 9 males in the SA sample and 26 females and 9
males in the US sample, but the gender differences were not significant between the two
groups.
There were significant differences in the ethnic groupings of the total sample (χ2
36.170, df = 4, p <.00) with 7.8% of the sample as Hispanic (0% SA & 20% US); 16.7 %
White non-Hispanic (5.5% SA & 34.3% US); 46.7% Asian/Pacific Islander (49.1% SA &
42.9% US), 24.4% Arabic (40% SA & 0% US) and 4.4% other (3% SA& 1%US).
There were also significant differences between the two groups in the category of
their first nursing degree (χ235.118, df = 5, p = .000). The following outlines the frequency of
nurses in each first degree type by country: 1) Associate degree (SA = 1; US = 13); 2)
Diploma (SA = 17; US = 1); 3) BSN (SA = 37; US = 16); 4) BS as a second degree in
nursing (SA = 0; US = 2); 5) MSN (SA = 0; US = 2; and 6) other (US = 1). For highest
16
degree earned, there were also significant differences (p < .00) by country: 1) Associate
degree (SA = 0; US = 8); 2) Diploma (SA = 16; US = 1); 3) BSN (SA = 39; US = 19); 4)
BS/BA other field (SA = 0; US = 3); and MSN (SA = 0; US = 3).
There were no significant differences in the two countries in the type of position
currently held by RNs in the study or in their full time or part time status. The majority of the
respondents in SA (91%) and US (97%) were clinical nurses and worked full time (SA
100%; US 80%).
An analysis was conducted to determine if any of the demographic variables were
significantly correlated with the study variables, transformational leadership, nurse-manager
collaborative behavior and job satisfaction, but none of the continuous demographic variables
were significantly correlated with the study variables.
RESULTS
The purpose of this study was to explore the relationship among the study variables –
transformational leadership, nurse-manager collaboration and job satisfaction. The study also
examined differences in these variables between nurses in US hospitals as compared to SA
hospitals. The following section presents the results of hypotheses testing.
Hypothesis 1
Hypothesis 1 stated that transformational leadership would be positively correlated
with job satisfaction. Surprisingly, this hypothesis was not supported. Since this study
showed a negative correlation between transformational leadership style and staff nurse job
satisfaction (r = -.493, p = .000). This finding is very different from other studies in the
literature which reported positive correlations between transformational leadership style and
nurse job satisfaction (Failla & Stichler, 2009).
Hypothesis 2
Hypothesis 2 stated higher levels of nurse-manager collaboration would be positively
related to job satisfaction. This hypothesis was not supported as well. It is surprising that this
study reports an inverse relationship between nurse-manager collaboration and job
satisfaction (r = -.602, p = .000), since most studies in the literature reported positive
correlations between nurse-manager collaboration and nurse job satisfaction (Stichler, 1990)
17
which makes this study’s result surprising. The disproportionate number of responses from
the SA hospitals as compared to the US hospitals could have played a role in this finding as
well, since nurses in the SA sample have less exposure and knowledge about nurse-manager
collaboration and its advantages in promoting a healthy work environment. There is also
more of a hierarchical influence on nursing in SA as compared to the US, so collaborative
behavior between nurses and their managers is not an expectation.
Hypothesis 3
Hypothesis 3 stated that there would be a positive relationship between
transformational leadership and nurse-manager collaboration. Hypothesis 3 was supported
since there was a significantly and strongly positive relationship between transformation
leadership and nurse-manager collaborative behavior (r = .643, p <. 000). This finding is not
surprising since the literature describes a transformational leader as one who is charismatic
and involved with their followers. Bass and Avolio (2004) also defined transformational
leaders as having idealized influence and behavior which positively promotes employee
acceptance of the leader’s mission and goals as their own; intellectual stimulation which
promotes innovative and creative thinking among their followers; and individualized
consideration which includes mentoring and coaching their followers to achieve far more
than they thought possible. All of these attributes of transformational leadership would
collaborative behavior between the nurse manager and his/her followers.
Hypothesis 4
Hypothesis 4 stated that there would be significant differences in the nurses’
perceptions of transformational leadership, nurse-manager collaboration, and job satisfaction
between hospitals in SA and the US. Hypothesis 4 was supported since there were significant
differences between nurses’ perceptions in SA as compared to the US on the MLQ –
Transformational Leadership (F = 5.915, df = 88, p < .004), the CBS (F = 21.5, df = 88, p <
.000), and IWS Job Satisfaction (F=4.643, df = 45, p < .000) as tested using the Independent
Samples Test (Levene’s test for equality of variance). For Transformational Leadership the
mean score was lower for SA nurses (M = 2.396, SD = .511) as compared to the US nurses
(M =2.79, SD = .739). For the Collaborative Behavior Scale, the mean score was also lower
for the SA nurses (M = 2.541, SD = .428) as compared to the US nurses (M = 3.117, SD =
18
.739). Since there were a greater percentage of SA nurses prepared at the BSN level in this
sample as compared to US nurses, it is assumed that some cultural differences may have
influenced the SA nurses’ perceptions of collaborative behavior between the clinical nurses
and their managers. Nursing still is perceived to be very hierarchical in SA as contrasted to
the hospitals in this study in the US. Nurse managers in SA also do not receive training in
leadership styles such as transformational leadership. The US nurse managers in this sample
were exposed to continuing education on the benefits and characteristics of transformational
leadership, because the US hospitals in this study were all Magnet designated or Magnet
aspiring which emphasizes transformational leadership.
Table 5 (in Appendix G) outlines these significant differences.
The mean score for IWS was significantly higher (p = .000) for SA nurses (M =
4.052, SD = .401) as compared to US nurses (M = 3.377, SD = .799). It is difficult to
interpret why there were significant differences in the two groups of nurses on the IWS.
Because most SA nurses are contract nurses coming from other countries, they may be more
satisfied in their jobs because they are there for a specific purpose and time. They may have
less expectation that the job should be “satisfying”. In contrast, the US nurses have an
expectation that the organization should ensure their satisfaction in their jobs, and when it
does, they are less satisfied. This is the first study that has shown an inverse correlation
between collaborative behavior and job satisfaction and between transformational leadership
and satisfaction, and it is difficult to understand this finding since it is not supported by other
research studies. Perhaps, SA and US nurses do not define satisfaction in terms of
transformational leadership or collaborative relationships with their managers. There may be
other factors that contribute more to their perceptions of satisfaction that were not measured
in this study. The IWS instrument may not have been sensitive to other factors that nurses’
consider important in their satisfaction.
POST-HOC ANALYSIS
Since the findings in Hypothesis 1 and Hypothesis 2 were so surprising, the data was
reviewed again and all recommended item reversals were eliminated, but when the reliability
of the IWS without reversals was tested, the Cronbach’s alpha dropped to a = .18. Therefore,
the original IWS with the reversed items was considered to be more appropriate for this
19
study, even though the expected positive correlations between transformational leadership
and job satisfaction and collaborative behavior and job satisfaction were not obtained.
Secondly, the data was separated by country and reanalyzed since there were significant
differences on the nurses’ perceptions of job satisfaction, collaborative behavior and
transformational leadership as outlined in Table 6 (in Appendix G), but the negative
correlations between transformational leadership and job satisfaction and collaborative
behavior and job satisfaction remained significant for both groups of nurses.
While it is difficult to explain why these findings have occurred in this study as
contrasted to other published studies, there may be some aberration with the use of the IWS
in these samples and with this study design. As already indicated, it may be that these
samples of nurses define job satisfaction in determine terms than the factors noted in the
IWS.
IMPLICATIONS FOR NURSING
The 20th century health organizations used the old alchemy of command and control
management structures and centralized decision making that was hindering the innovation
and development of the health organizations. The 21st century HCOs are demanding a new
alchemy that can change and transmute the way health settings are designed, operated and
evaluated. Decentralized power and decision making, empowered staff, evidence based care,
managers who lead more with influence than power, and nurse-managers who collaborate
with staff are practices needed in this new alchemy (Porter-O’Grady & Malloch, 2010). The
future of the nursing profession is associated with the willingness of the leaders to change the
way they lead (Porter-O’Grady & Malloch, 2010). The findings of this study indicate several
important findings. First, this is the first study that demonstrates a significant and strong
relationship between collaboration and transformational leadership. There were more BS
prepared nurses in the SA sample than the US sample but no higher degreed nurses, so
further education and training are needed to advance their knowledge in transformational
leadership and collaboration. This is especially true in a culture like SA where the female
exerts less power and control in all aspects of life including in the healthcare profession.
Since Magnet designation encourages collaborative behavior and transformational
20
leadership, understanding their relationship to job satisfaction is critical for nursing as a
profession.
LIMITATIONS The design and methodology of this study were assessed for potential threats and
limitations by using Polit and Beck’s (2004) methodology. In the next section, threats to
internal and external validity will be discussed.
Internal Validity
According to Polit and Beck (2004) internal validity refers to: “ the extent to which it
is possible to make an inference that the independent variable is truly causing or influencing
the dependant variable and that the relationship between the two is not the spurious effect on
an extraneous variable” (p. 213). After the assessment of the internal validity of this study
potential threats were identified in the history, selection bias, testing effects, instrumentation,
and research design. The threats in these domains will be described below.
HISTORY
Polit and Beck (2004) suggest the occurrence of external events can affect the
dependent variable. It is difficult to predict the unknown influences in the respondents’
background or in the organization that could have affected the finding of this study including
recent managerial announcements or organizational changes.
SELECTION BIAS
Selection bias was not a consideration in this study since a random sampling method
was used. The participants in this study comprising the study sample may not have been
representative of the general population of the nurses who were not included in the sample.
However, the US hospital nurses were in the process of completing other surveys required by
the organization and thus might have been reluctant to participate in this survey. The nurses
in SA hospitals may not have been accustomed to completing survey instruments pertaining
to their perceptions of these study variables or other similar variables and therefore may have
been reluctant to complete the survey instruments.
Furthermore, a selection bias might have occurred as nurses interested in the study
variables of transformational leadership, collaborative behavior or job satisfaction were more
21
inclined to participate and complete the study instruments whereas others may have elected
not to participate. It could have been that nurses who were less satisfied elected to participate
in the study because of their curiosity about the study variables which may have affected the
findings. It is unknown how multiple instruments in the same survey or the survey’s length
may have affected the participant responses to the study instruments.
The disproportionate number of responses from the SA hospitals as compared to the
US hospitals was a limitation to the study since the groups were not of equal size for
comparison.
TESTING EFFECTS
Environmental factors might have posed a limitation for this study. The instruments
were self administered by the subjects and no attempt was made by the researcher to control
distractions or interruptions. Respondents may have completed the self- report instruments in
a way that they believed to be most socially acceptable rather than their true feelings;
however, the researcher has to assume that the respondents’ answers were representative of
their true feelings.
INSTRUMENTATION
Three instruments with known psychometric properties were used to quantify the
variables in the study. The three instruments were used in prior studies and were appropriate
for the population and the specific variables in this study. The findings that collaboration and
transformational leadership were inversely related to job satisfaction are a finding not
supported by other studies in the literature. It could be that the IWS did not function as well
as expected in this study with this sample. Perhaps the factors that comprise the IWS are not
as significant to this sample of nurses (pay, autonomy, task requirement, organization
policies, nurse-nurse interaction, and nurse-physician interaction). It is not known how other
instruments measuring the same constructs would alter the results seen in this study.
RESEARCH DESIGN
This study used a cross-sectional design where the results represent a single point in
time of measuring the perceptions of nurses related to the leadership style of their manager,
22
their perceptions of nurse-manager collaboration and their job satisfaction. Studying these
same variables over time may have yielded different results.
External Validity
The external validity of the study denotes the generalizability of the study findings
beyond the parameters of the current study. Although a random sampling method was used
from a convenience sample of hospitals, the survey size was smaller than expected to power
the study, so the results of this study might not be generalizable to a larger population. The
subjects in this study in two SA hospitals and the three US hospitals in the southwest region
of the United States might be atypical of the population of interest in SA or US (Polit &
Beck, 2004).The small US response rate (20%) was also a limitation of the study.
SUGGESTIONS FOR FURTHER RESEARCH
A replication of this study on a larger sample in other settings in the US and in SA is
recommended to be able to generalize the study results. Further research related to nurse job
satisfaction using other instruments should be performed which includes the component of
organizational commitment in the healthcare setting. This study should also be replicated
using a different instrument to measure job satisfaction since the findings from this study are
so different than what has been previously reported in the literature. Perhaps the instrument
was not sensitive to the sample in this study and their perceptions of what factors constitute
job satisfaction.
CONCLUSIONS
This study used a cross-sectional descriptive correlation and comparative design to
examine the relationship and differences in transformational leadership, nurse manager
collaborative behavior and job satisfaction in two SA hospitals and three US hospitals. Bass
and Avolio’s Augmentation Model of Transactional and Transformational Leadership,
process, and outcome model was used as the theoretical framework to describe the
relationship between the study variable. The results of this study supported the association
between transformational leadership styles, nurse-manager collaboration. However, the result
of this study did not support the association between transformational leadership style, nurse-
manager collaboration and staff nurse job satisfaction. Many literatures reported positive
23
correlations between transformational leadership style, nurse-manager collaboration and
nurse job satisfaction which make this study result surprising. The disproportionate number
of responses from the SA hospitals as compared to the US hospitals could have play some
role in the result as most of the responses were from the SA sample. These nurses who has
less exposure and knowledge about transformational leadership style and nurse-manager
collaboration and its advantages in promoting a healthy work environment and empowering
and growing staff nurses.
24
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Chin Chen, H., & Baron, M. (2006). Nursing directors’ leadership styles and faculty members’ job satisfaction. Journal of Nursing Education, 45(10), 404-411.
DeCremer, D. (2003). Why inconsistent leadership is regarded as procedurally unfair: The importance of social self-esteem concerns. European Journal of Social Psychology, 33(4), 535-550.
Doran, D. (2003). Nursing sensitive outcomes: State of the sciences. Sudbury, Canada: Jones and Bartlett Publishers.
Dumpe, M. (1996). Making a change: The importance of administrative support. Nursing Management, 27(5), 61.
Failla, K. & Stichler, J. (2008). Manager and staff perceptions of the manager’s leadership style. JOAN, 38(11), 480-487.
Grieshaber L. D., Parker P., & Deering J. (1995). Job satisfaction of nursing assistants in long-term care. The Health Care Supervisor, 13(4), 18-28.
Hinkina, T. & Schriesheimb, C. (2008). A theoretical and empirical examination of the transactional and non-leadership dimensions of the multifactor leadership questionnaire (MLQ). The Leadership Quarterly, 19(5), 501-513.
Homans, G. C. (1950). The human group. New York, NY: Harcourt, Brace and Company.
Huber, D. L. (2006). Leadership and nursing care management. Philadelphia, PA: Saunders Elsevier.
Mcguire, E. & Kennerly, S. (2006). Nurse manager as transformational and transactional leaders. Nursing Economics, 24(4), 179-186.
Medley, F. & Larochelle, D. (1995). Transformational leadership and job satisfaction. Nursing Management, 26(9), 64JJ.
Nielsen, K., Yarker, J., Brenner, S., Randall, R., & Borg, V. (2008). The importance of transformational leadership style for the well-being of employees working with older people. Journal of Advanced Nursing, 63(5), 465-475.
O’Connor, M. (1996). “Manager as developer”: Facilitating collaboration. Nursing Management, 27(5), 61.
Polit, D. F. & Beck, C. T. (2004). Nursing research: Principles and methods (7th ed.). Philadelphia, PA: Lippincott, Williams & Wilkins.
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Porter-O’Grady, T. & Malloch, K. (2010). Innovation leadership. Sudbury, MA: Jones & Bartlett Publishers.
Rogg, K. L., Schmidt, D. B., & Shull, C. (2001). Human resource practices, organizational climate, and customer satisfaction. Journal of Management 27, 431-449.
Roussel, L. (2009). Management and leadership for nurse administrators (5th ed.). Sudbury, MA: Jones and Bartlett.
Stamps, P. & Piedmonte, E. (1986). Nurses and work satisfaction: An index for measurement. Ann Arbor, MI: Health Administration Press.
Stichler, J. (1990). The effects of collaboration, organizational climate, and job stress on job satisfaction and anticipated turnover in nursing (Doctoral dissertation). University of San Diego, San Diego, CA.
Stichler, J. (2009). Wicked problems in designing healthcare facilities. Journal of Nursing Administration, 39(10), 405-408.
Stichler, J. F. (1995). Professional interdependence: The art of collaboration. Advanced Practice Nursing Quarterly, 1, 53 – 61.
Stordeur, S., D’hoore, W., & Vandenberghe, C. (2001). Leadership, organizational stress, and emotional exhaustion among nursing hospital staff. Journal of Advanced Nursing 35(4), 533-542.
Vollers, D., Hill, E., Roberts, C., Ambaugh, L., & Brenner, Z. (2009). AACN's healthy work environment standards and an empowering nurse advancement system. Critical Care Nurse, 29(6), 20-28.
Welch, M., & Tulbert, B. (2000). Practitioners' perspectives of collaboration: A social validation and factor analysis. Journal of Educational & Psychological Consultation, 11(3-4), 357-378. doi:10.1207/S1532768XJEPC113&4
26
APPENDIX A
DEMOGRAPHIC SURVEY
27
TRANSFORMATIONAL LEADERSHIP AND COLLABORATIVE NURSE
MANAGEMENT
AND THEIR RELATIONSHIP TO STAFF NURSE JOB SATISFACTION
DEMOGRAPHIC SURVEY
Directions: These questions concern the backgrounds of those who respond to this survey.
As with all answers to this survey, your responses will be kept confidential. Please circle the
appropriate number or fill in the blank.
Name of your hospital ____________________________________________________
1. What is your gender?
a. Female
b. Male
2. What is your age in years? ______________
3. What best describes your Ethnic Group?
a. Hispanic
b. Black (not Hispanic)
c. White (not Hispanic)
d. Asian/Pacific Islander
e. Arabic
f. Other
4. What was your first nursing degree?
a. Associate Degree
b. Diploma
c. Baccalaureate – Nursing
d. Baccalaureate – nursing as second degree
e. Master’s Entry Program in Nursing (MEPN)
f. Master in Nursing
g. Master (Other)
h. PhD in Nursing
i. PhD (Other)
j. Other (please specify) _____
28
5. What was the year your first nursing degree was completed in? _______
6. What Country was your first nursing degree granted in? _______
7. What is your highest earned degree?
a. Associate degree
b. Diploma
c. Baccalaureate (Nursing)
d. Baccalaureate (Other field)
e. Master’s (Nursing)
f. Master’s (Other field)
g. Doctoral Degree (Nursing)
h. Doctoral Degree (other field)
8. How many years have you been working at your hospital as a registered nurse? ____
9. What best describes your current position?
a. Associate nurse
b. Clinical nurse
c. Advanced clinician
d. Other (please specify) ___________________________
10. What best describes your present position?
a. Full time
b. Part-time
c. Per diem
d. Traveler
e. Other (please specify) ___________________________
11. What is the gender of your manager or supervisor (the one who directly supervises
your work)?
a. male
b. female
29
APPENDIX B
MULTIFACTOR LEADERSHIP QUESTIONNAIRE
30
For use by Eman Almutairi only. Received from Mind Garden, Inc. on April 14, 2010 MLQ Multifactor Leadership Questionnaire
Rater Form (5x-Short) Name of Leader: _________________________________________________ Date: ______________ Organization ID #: _____________________________ Leader ID #: __________________________________ This questionnaire is to describe the leadership style of the above-mentioned individual as you perceive it. Please answer all items on this answer sheet. If an item is irrelevant, or if you are unsure or do not know the answer, leave the answer blank. Please answer this questionnaire anonymously. IMPORTANT (necessary for processing): Which best describes you? ___ I am at a higher organizational level than the person I am rating. ___ The person I am rating is at my organizational level. ___ I am at a lower organizational level than the person I am rating. ___ I do not wish my organizational level to be known. Forty-five descriptive statements are listed on the following pages. Judge how frequently each statement fits the person you are describing. Use the following rating scale: Not at all Once in a while Sometimes Fairly often Frequently, if not always 0 1 2 3 4 THE PERSON I AM RATING. . . 1. Provides me with assistance in exchange for my efforts .....................................................................0 1 2 3 4 2. Re-examines critical assumptions to question whether they are appropriate.......................................0 1 2 3 4 3. Fails to interfere until problems become serious.................................................................................0 1 2 3 4 4. Focuses attention on irregularities, mistakes, exceptions, and deviations from standards...................0 1 2 3 4 5. Avoids getting involved when important issues arise..........................................................................0 1 2 3 4 6. Talks about their most important values and beliefs ...........................................................................0 1 2 3 4 7. Is absent when needed.........................................................................................................................0 1 2 3 4 8. Seeks differing perspectives when solving problems ..........................................................................0 1 2 3 4 9. Talks optimistically about the future ...................................................................................................0 1 2 3 4 10. Instills pride in me for being associated with him/her.........................................................................0 1 2 3 4 11. Discusses in specific terms who is responsible for achieving performance targets .............................0 1 2 3 4 12. Waits for things to go wrong before taking action ..............................................................................0 1 2 3 4 13. Talks enthusiastically about what needs to be accomplished ..............................................................0 1 2 3 4 14. Specifies the importance of having a strong sense of purpose ............................................................0 1 2 3 4 15. Spends time teaching and coaching.....................................................................................................0 1 2 3 4 Continued => For use by Eman Almutairi only. Received from Mind Garden, Inc. on April 14, 2010 MLQ, © 1995 Bruce Avolio and Bernard Bass. All Rights Reserved. Published by Mind Garden, Inc., www.mindgarden.com
Not at all Once in a while Sometimes Fairly often Frequently, if not always
31
0 1 2 3 4 16. Makes clear what one can expect to receive when performance goals are achieved...........................0 1 2 3 4 17. Shows that he/she is a firm believer in “If it ain’t broke, don’t fix it.”................................................0 1 2 3 4 18. Goes beyond self-interest for the good of the group ...........................................................................0 1 2 3 4 19. Treats me as an individual rather than just as a member of a group....................................................0 1 2 3 4 20. Demonstrates that problems must become chronic before taking action.............................................0 1 2 3 4 21. Acts in ways that builds my respect ....................................................................................................0 1 2 3 4 22. Concentrates his/her full attention on dealing with mistakes, complaints, and failures.......................0 1 2 3 4 23. Considers the moral and ethical consequences of decisions................................................................0 1 2 3 4 24. Keeps track of all mistakes..................................................................................................................0 1 2 3 4 25. Displays a sense of power and confidence ..........................................................................................0 1 2 3 4 26. Articulates a compelling vision of the future.......................................................................................0 1 2 3 4 27. Directs my attention toward failures to meet standards.......................................................................0 1 2 3 4 28. Avoids making decisions.....................................................................................................................0 1 2 3 4 29. Considers me as having different needs, abilities, and aspirations from others...................................0 1 2 3 4 30. Gets me to look at problems from many different angles....................................................................0 1 2 3 4 31. Helps me to develop my strengths.......................................................................................................0 1 2 3 4 32. Suggests new ways of looking at how to complete assignments .........................................................0 1 2 3 4 33. Delays responding to urgent questions................................................................................................0 1 2 3 4 34. Emphasizes the importance of having a collective sense of mission...................................................0 1 2 3 4 35. Expresses satisfaction when I meet expectations ................................................................................0 1 2 3 4 36. Expresses confidence that goals will be achieved ...............................................................................0 1 2 3 4 37. Is effective in meeting my job-related needs.......................................................................................0 1 2 3 4 38. Uses methods of leadership that are satisfying....................................................................................0 1 2 3 4 39. Gets me to do more than I expected to do...........................................................................................0 1 2 3 4 40. Is effective in representing me to higher authority ..............................................................................0 1 2 3 4 41. Works with me in a satisfactory way...................................................................................................0 1 2 3 4 42. Heightens my desire to succeed ..........................................................................................................0 1 2 3 4 43. Is effective in meeting organizational requirements............................................................................0 1 2 3 4 44. Increases my willingness to try harder ................................................................................................0 1 2 3 4 45. Leads a group that is effective.............................................................................................................0 1 2 3 4
32
APPENDIX C
INTRODUCTORY LETTER
33
Introductory Letter and Consent for Potential Nurses to Participate in
An Exploratory Study of Relationships among Transformational Leadership, Collaborative nurse management and Staff Job Satisfaction
Dear Colleague,
Eman Almutairi, RN, RM and Jaynelle F. Stichler, DNSc, RN, FAAN are conducting a research study to explore the
relationship among transformational leadership, nurse-manager collaboration and staff job satisfaction. The study will
consist of your taking a survey to assess your perceptions of your job satisfaction, your leadership style and the collaborative
relationship between you and your manager. There will be approximately 175 nurses from sharp hospitals participating in
the study.
Your name has been chosen at random among the nurses at your hospital, and your participation in this study is completely
voluntary. Your completion of the study forms indicates your willingness to participate. If you do not wish to participate,
you do not need to do anything further. If you wish to proceed, please read the California Experimental Subject’s Bill of
Rights form provided with this letter and complete the study surveys for the study. You can decline to participate in the
study by not completing the survey questions. It is estimated that it will take approximately 15-20 minutes for you to
complete the questionnaires.
To maintain the confidentiality of your individual responses, you are requested not to write your name anywhere on the
packet and your demographic and study surveys will be kept in a locked area and will not be available to anyone not directly
involved in this study’s data collection or analysis. Your individual responses will be aggregated with the responses of other
nurse subjects and reported only in the aggregate form. No personal identifying information will be reported.
If you have any questions, you may reach Dr. Jaynelle Stichler (SDSU) at 619-871-0298 or Eman Almutairi 619-819-9101
(SDSU). If you have any questions about your rights as a participant in this study or desire to report research-related
problems, you may contact the Human Subjects Protection Program at SDSU (619-594-6622) or Sharp’s Office for the
Protection of Human Research Subjects (858-499-4836)
If you volunteer to participate, please complete the enclosed forms including: 1) Demographic survey; and the following
surveys for 1) Multifactor’s Leadership Questionnaire (MLQ), 2) the Collaborative Behavior Scale’s (CBS), and 3) job
satisfaction (IWS). After completing the forms, please put them in the enclosed and self-addressed, stamped envelope to
Eman Almutairi. If you decline to participate, you do not need to do anything further but we are grateful for your
consideration, however. Thank you for your time and consideration of this study.
Please return by January- February
Eman Almutairi, RN, RM Jaynelle F. Stichler, DNSc, RN, FAAN
SDSU Graduate Student Professor SDSU
Principal Investigator Co-Investigator
34
APPENDIX D
FLYER
35
FLYER
Who: Eman Almutairi, RN, SDSU Graduate Student What: 3 short surveys that asks questions about your perception of the leadership style and collaborative behavior of your nurse manager and your job satisfaction. When: January – February 2011
How: If you need additional information, please contact Eman Almutairi at 619-819-9101
Nurses are invited to Participate in study on Transformational Leadership And Collaborative Nurse
management As Perceived By The Clinical Nurse And Its Relationship To Job Satisfaction.
36
APPENDIX E
NURSE-MANAGER COLLABORATIVE
BEHAVIOR SCALE
37
NURSE-MANAGER
COLLABORATIVE BEHAVIOR SCALE Directions: The purpose of this scale is to determine the extent of
collaboration behaviors which generally exist between you and the
managers with whom you work. (For each statement check the one box
that indicates how often you believe that each behavioral statement
occurs.) There is no right or wrong answers. Please answer each item as best
as you can.
Rarely
1 Sometimes
2 Often
3 Nearly Always
4 1. We feel free to share ideas with one another.
2. We acknowledge one another. 3. We support each other as team members.
4. We work as partners. 5. We are committed to working together as a team.
6. We trust each one another. 7. There is a sharing of expertise and talents between us.
8. We work as “equals” or “partners” for the accomplishment of some
goals.
9. We work together as a team. 10. My opinions are listened to. 11. I feel that my input is truly valued. 12. We work together as associates. 13. There is a felling of mutual regard and respect.
14. We make an effort to resolve any conflicts which arise to our mutual
satisfaction.
15. We both actively participate in the relationship in order to meet our
patient care goals.
38
16. We share information openly with one another.
17. We problem solve together. 18. We recognize the need to have a sense of “give and take” in the
relationship.
19. We recognize our interdependence with one another in order to meet
our goals.
20. We are committed to the process of working together to meet our
goals.
Used with permission: Stichler
14365 Cheri Lane, Poway, CA 92064 [email protected]
39
APPENDIX F
THE INDEX OF WORK SATISFACTION
40
Agree Disagree1. My present salary is satisfactory. 1 2 3 4 5 6 72. Nursing is not widely recognized as being an
important profession. 1 2 3 4 5 6 7
3. The nursing personnel on my service pitch in and help one another out when things get in a rush.
1 2 3 4 5 6 7
4. There is too much clerical and “paperwork” required of nursing personnel in this hospital. 1 2 3 4 5 6 7
5. The nursing staff has sufficient control over scheduling their own shifts in my hospital. 1 2 3 4 5 6 7
6. Physicians in general cooperate with nursing staff on my unit. 1 2 3 4 5 6 7
7. I feel that I am supervised more closely than is necessary. 1 2 3 4 5 6 7
8. It is my impression that a lot of nursing personnel at this hospital are dissatisfied with their pay.
1 2 3 4 5 6 7
9. Most people appreciate the importance of nursing care to hospital patients. 1 2 3 4 5 6 7
10. It is hard for new nurses to feel ‘at home’ in my unit. 1 2 3 4 5 6 7
11. There is no doubt whatever in my mind that what I do on my job is really important. 1 2 3 4 5 6 7
12. There is a great gap between the administration of this hospital and the daily problems of the nursing service.
1 2 3 4 5 6 7
13. I feel I have sufficient input into the program of care for each of my patients. 1 2 3 4 5 6 7
14. Considering what is expected of nursing service personnel at this hospital, the pay we get is reasonable.
1 2 3 4 5 6 7
15. I think I could do a better job if I did not have so much to do all the time. 1 2 3 4 5 6 7
16. There is a good deal of teamwork and cooperation between various levels of nursing personnel on my service.
1 2 3 4 5 6 7
41
Agree Disagree17. I have too much responsibility and not enough
authority. 1 2 3 4 5 6 7
18. There are not enough opportunities for advancement of nursing personnel at this hospital.
1 2 3 4 5 6 7
19. There is a lot of teamwork between nurses and doctors on my own unit. 1 2 3 4 5 6 7
20. On my service, my supervisors make all the decisions. I have little direct control over my own work.
1 2 3 4 5 6 7
21. The present rate of increase in pay for nursing service personnel at this hospital is not satisfactory.
1 2 3 4 5 6 7
22. I am satisfied with the types of activities that I do on my job. 1 2 3 4 5 6 7
23. The nursing personnel on my service are not as friendly and outgoing as I would like. 1 2 3 4 5 6 7
24. I have plenty of time and opportunity to discuss patient care problems with other nursing service personnel.
1 2 3 4 5 6 7
25. There is ample opportunity for nursing staff to participate in the administrative decision-making process.
1 2 3 4 5 6 7
26. A great deal of independence is permitted, if not required, of me. 1 2 3 4 5 6 7
27. What I do on my job does not add up to anything really significant. 1 2 3 4 5 6 7
28. There is a lot of “rank consciousness” on my unit: nurses seldom mingle with those with less experience or different types of educational preparation.
1 2 3 4 5 6 7
29. I have sufficient time for direct patient care. 1 2 3 4 5 6 730. I am sometimes frustrated because all of my
activities seem programmed for me. 1 2 3 4 5 6 7
31. I am sometimes required to do things on my job that are against my better professional nursing judgment.
1 2 3 4 5 6 7
42
Agree Disagree32. From what I hear about nursing service
personnel at other hospitals, we at this hospital are being fairly paid.
1 2 3 4 5 6 7
33. Administrative decisions at this hospital interfere too much with patient care. 1 2 3 4 5 6 7
34. It makes me proud to talk to other people about what I do on my job. 1 2 3 4 5 6 7
35. I wish the physicians here would show more respect for the skill and knowledge of the nursing staff.
1 2 3 4 5 6 7
36. I could deliver much better care if I had more time with each patient. 1 2 3 4 5 6 7
37. Physicians at this hospital generally understand and appreciate what the nursing staff does.
1 2 3 4 5 6 7
38. If I had the decision to make all over again, I would still go into nursing. 1 2 3 4 5 6 7
39. The physicians at this hospital look down too much on the nursing staff. 1 2 3 4 5 6 7
40. I have all the voice in planning policies and procedures for this hospital and my unit that I want
1 2 3 4 5 6 7
41. My particular job really doesn’t require much skill or “know-how”. 1 2 3 4 5 6 7
42. The nursing administrators generally consult with the staff on daily problems and procedures.
1 2 3 4 5 6 7
43. I have the freedom in my work to make important decisions as I see fit, and can count on my supervisors to back me up.
1 2 3 4 5 6 7
44. An upgrading of pay schedules for nursing personnel is needed at this hospital. 1 2 3 4 5 6 7
43
APPENDIX G
TABLES
44
Table 1. Demographics Comparisons
SA USA Statistical
difference
Gender Female
Male
n=46, 84%
n=9, 16%
n=26, 80%
n=9, 20%
Ethnicity White
Hispanic
Asian
Arabic
Other
n=3, 5.5%
n=0, 0%
n=27, 49.1%
n=22, 40%
n=3, 5.5%
n=12, 34.3%
n=7, 20%
n=15, 42.9%
n=0, 0%
n=1, 2.9%
χ2 36.170, df = 4, p
<.00
First
Nursing
degree
BSN
ADN
Masters
Diploma
B-nsg2nd deg
n=37, 67.3%
n=1, 1.8%
n=0, 0%
n=17, 30.9%
n=0, 0%
n=16, 45.7%
n=13, 37.1%
n=2, 5.7%
n=1, 2.9%
n=2, 5.7%
χ235.118, df = 5, p =
.000
(table continues)
45
Table 1. (continued)
Highest
degree
earned
BSN
ADN
Masters
Diploma
BA/BS other field
n=39, 70.9%
n=0, 0%
n=0, 0%
n=16, 29.1%
n=0, 0%
n=19, 54.3%
n=8, 22.9%
n=3, 8.6%
n=1, 2.9%
n=4, 11.4%
p < .00
Current
position
by
country
Asso Nurse
Clinical Nurse (
Adv clinician
Other
n=1, 1.8%
n=50, 90.9%
n=0, 0%
n=4, 7.3%
n=0, 0%
n=34, 97.1%
n=1, 2.9%
n=0, 0%
Work
Time by
country
FT
PT
n=55, 100%
n= 0, 0%
n=28, 80%
n=7, 20%
Gender
by
Manager
Female
Male
n=43, 78.2%
n= 12, 21.8%
n=35, 100%
n= 0, 0%
Note n = 90
46
Table 2. Instrument Reliabilities
Instrument Current study Reported
MLQ .896 .70
CBS .95 .96
IWS .877 .69 - .83
Note. N = 90
Table 3. Total Scale Mean Scores for Total Sample
Mean Std. Deviation N
Total_IWS_Scale 3.7896 .67202 90 MLQ Transform Scale 2.5500 .63600 90 Collaborative Behavior Scale
2.7656 .63182 90
Table 4. Mean Scores for Study Variables by Country
Country N Mean Std.
Deviation Std. Error
Mean
Total_IWS_Scale Saudi Arabia
55 4.0524 .40143 .05413
USA 35 3.3766 .79931 .13511
Collaborative Behavior Scale
Saudi Arabia
55 2.5418 .42750 .05764
USA 35 3.1171 .73923 .12495
MLQ Transform Scale Saudi Arabia
55 2.3964 .51116 .06892
USA 35 2.7914 .73869 .12486
47
Table 5. Correlations Among Study Variables
Total_IWS_Scale
MLQ Transform
Scale
Collaborative
Behavior
Scale
Total_IWS_Scale Pearson
Correlation
1 -.493** -.602**
Sig. (2-tailed) .000 .000
N 90 90 90
MLQ Transform Scale Pearson
Correlation
-.493** 1 .643**
Sig. (2-tailed) .000 .000
N 90 90 90
Collaborative Behavior
Scale
Pearson
Correlation
-.602** .643** 1
Sig. (2-tailed) .000 .000
N 90 90 90
**. Correlation is significant at the 0.01 level (2-tailed).
48
Table 6. Test of Significant Differences between SA and US Nurses Perceptions on Study Variables
Independent Samples Test
Levene's
Test for
Equality of
Variances t-test for Equality of Means
F Sig. t df
Sig.
(2-
tailed)
Mean
Difference
Std. Error
Difference
95%
Confidence
Interval of the
Difference
Lower Upper
Total_IWS_Scale 25.539 .000 .000 .67582 .12714 .42316 .92848
Equal
variances
not
assumed
4.643 45 .000 .67582 .14555 .38268 .96895
Collaborative
Behavior Scale
21.526 .000 .000 -.57532 .12294 -
.81964
-
.33101
Equal
variances
not
assumed
-
4.181
49 .000 -.57532 .13761 -
.85191
-
.29874
MLQ Transform
Scale
5.915 .017 .004 -.39506 .13173 -
.65685
-
.13328
Equal
variances
not
assumed
-
2.770
55 .008 -.39506 .14262 -
.68092
-
.10921
